Provider First Line Business Practice Location Address:
615 S BAKER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98402-2318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-200-0741
Provider Business Practice Location Address Fax Number:
253-651-7411
Provider Enumeration Date:
08/22/2023